Out-of-Hospital Cohort Treatment of Coronavirus Disease 2019 Patients with Mild Symptoms in Korea: an Experience from a Single Community Treatment Center

Park, Peong Gang; Kim, Chang Hyup; Heo, Yoon; Kim, Tae Suk; Park, Chan Woo; Kim, Choong-Hyo

To allocate medical resources efficiently, a novel institution with the purpose of treating patients with cohort isolation out of the hospital, namely the Community Treatment Center (CTC), was designed and implemented in Korea. The CTC is an independent building outside a hospital based on the concept that patients with mild symptoms do not require advanced medical resources, although they require isolation to prevent transmission and active surveillance in case they develop more severe symptoms. Utilizing CTCs has several advantages compared to isolating patients at home: strict isolation with active surveillance of patients is possible; it also lowers the risk associated with collecting viral specimens and the possibility of cross-infections. As of March 18, a total of 12 CTCs are operating in Korea, and more CTCs in other regions are preparing to open shortly. Herein, we report the initial management and treatment results of patients at Gyeongbuk-Daegu 7 CTC, one of the largest CTCs in Korea. The building currently being utilized as Gyeongbuk-Daegu 7 CTC, located in Gumi, Gyeongbuk, was previously a dormitory building owned by a private company and is now renovated as a CTC. Healthcare providers currently working at the center consist of 7 physicians, 5 nurses and 1 radiologic technician from Kangwon National University Hospital; 7 public health doctors from the Ministry of Health and Welfare; and volunteer healthcare providers (12 nurses and 12 nursing assistants). Physicians worked on a two-shift system, taking charge of active surveillance of patients and collecting viral specimens from patients. Nurses worked on a three-shift system and assisted physicians with such tasks. The clean zone, where healthcare providers work, is separated from the patients' zone, where patients reside, to prevent cross-infection between healthcare providers and patients ( Fig. 1) . Healthcare providers are required to wear personal protective equipment (PPE) of inner and outer gloves, N95 respirator, goggles, and hooded coveralls when entering the patients' zone. 5 Patients were also instructed to stay in their rooms to prevent cross-infection between patients. In the patients' zone, two negative pressure rooms for a mobile radiograph imaging facility and a doctor's office was installed to examine patients with symptoms of coronavirus. Candidates for CTC admission were confirmed COVID-19 patients with real-time reverse transcriptase polymerase chain reaction (rRT-PCR) method and considered by authorities as patients without severe symptoms using guidelines from the Korea Centers for Disease Control and Prevention (KCDC). 6,7 Exclusion criteria were as follows: patients with underlying chronic severe medical conditions such as heart failure or chronic kidney disease and patients with high fever or dyspnea -all of whom likely required advanced medical treatment. Patients admitted were initially checked for their symptoms and underlying diseases; patients 55 years of age or older received routine chest radiographs to rule out asymptomatic pneumonia. After their admission, their body temperature was monitored twice a day. To minimize access of healthcare providers to the patients' zone and to communicate more effectively, we encouraged patients to install a specialized mobile application (inPHR ® , SoftNet, Seoul, Korea) to report their body temperature, of which adherence reached more than 80% (Fig. 2) . Patients who were inexperienced in using a mobile